Managing Rectal Bleeding: When to See a Gastroenterologist or Surgeon

Hemorrhoidal bleeding issue?

Hello, doctor.
Recently, my mother, who is 64 years old, has experienced blood in her stool, staining the toilet red.
Although she mentioned that her hemorrhoids have protruded and could usually be pushed back in, this time it seems impossible as forcing it back causes bleeding! Therefore, I persuaded her to see a gastroenterologist.
The doctor prescribed hemostatic medication and scheduled a colonoscopy (without anesthesia) for the next few days.
After taking the hemostatic medication, the bleeding stopped, and there was no blood during bowel movements.
However, due to the need for a low-residue diet, after stopping the hemostatic medication, she experienced bleeding again when straining during bowel movements.
Since she needs to take laxatives for bowel cleansing, I would like to ask if it is safe to proceed with the colonoscopy if the hemorrhoids continue to bleed, or should we cancel the colonoscopy and consult a colorectal surgeon instead?

KALI, 40~49 year old female. Ask Date: 2023/12/27

Dr. Zhang Shuhao reply Surgery

At this age, if there is frequent bleeding and a colonoscopy has not been performed, it is generally recommended to arrange for a colonoscopy to rule out any colonic lesions.
Even if there are hemorrhoids, a colonoscopy can be performed without anesthesia.
During the bowel preparation, if bleeding occurs, it is advisable to take warm sitz baths and use hemorrhoid ointment.
If the bleeding is significant, it is important to contact the facility performing the examination to determine whether to continue with the bowel preparation.
In most cases, it is recommended to complete the examination before addressing the hemorrhoid issue.

Reply Date: 2023/12/27

More Info

When managing rectal bleeding, especially in a case like your mother's, it's crucial to approach the situation with caution and a clear understanding of the potential underlying causes. Rectal bleeding can arise from various conditions, including hemorrhoids, anal fissures, diverticular disease, polyps, or even more serious conditions like colorectal cancer. Given your mother's age and the symptoms you've described, it is wise to seek medical attention promptly.

In your mother's case, the fact that she has experienced bleeding associated with hemorrhoids is significant. Hemorrhoids can indeed cause bright red blood during bowel movements, and if they become thrombosed or inflamed, they can lead to more severe bleeding. The fact that she was able to push the hemorrhoid back previously but is now unable to do so without bleeding suggests that there may be an exacerbation of her condition.
The gastroenterologist's decision to prescribe hemostatic medications and schedule a colonoscopy is appropriate. A colonoscopy is a valuable diagnostic tool that allows for direct visualization of the colon and rectum, enabling the physician to identify any abnormalities, including hemorrhoids, polyps, or lesions that could be causing the bleeding. It is also possible for the physician to treat certain conditions during the procedure, such as banding hemorrhoids or removing polyps.

Regarding your question about whether to proceed with the colonoscopy if the hemorrhoids are still bleeding, it is essential to communicate openly with the gastroenterologist. If the bleeding is significant, it may be advisable to postpone the colonoscopy until the bleeding is under control. This is because active bleeding can obscure the view during the procedure and may complicate the interpretation of findings. Additionally, if the bleeding is severe, it may pose a risk during the procedure itself.

If the gastroenterologist feels that the bleeding is manageable and not severe, they may still proceed with the colonoscopy. However, if there are concerns about the safety of performing the procedure while she is actively bleeding, they may recommend consulting a colorectal surgeon. A colorectal surgeon specializes in surgical interventions for conditions affecting the colon, rectum, and anus, and they may provide additional options for managing the hemorrhoids, especially if they are causing significant discomfort or recurrent bleeding.

In summary, it is crucial to keep the lines of communication open with the healthcare providers involved in your mother's care. If the bleeding persists or worsens, or if she experiences other concerning symptoms such as severe pain, dizziness, or changes in bowel habits, it is essential to seek immediate medical attention. The decision to proceed with a colonoscopy or refer to a colorectal surgeon should be based on a thorough assessment of her current condition, the severity of the bleeding, and the potential risks involved.
In the meantime, managing her diet, ensuring adequate hydration, and possibly using topical treatments for hemorrhoids may help alleviate some symptoms. However, any changes to her treatment plan should be made in consultation with her healthcare provider.

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